Significant advances have been made in the medical and dental fields to better enable doctors to view and observe the treatment area during surgical procedures in the medical and dental field. Where previously a doctor used a head-mounted magnifying eyepiece to view the tissue area, now doctors routinely use electronic imaging apparatus to display an enlargement of the tissue area so that the area can be viewed on a screen with selected angles, intensities, colors, and so that a number of persons can simultaneously view the same tissue area of interest. Moreover, with electronic imaging, the images can be magnified for viewing, stored for archive purposes, and can be viewed at remote locations by students and other interested parties.
Endoscopes of various types using imaging equipment, namely videoscopes, include imaging apparatus for viewing tissue areas during traditional invasive and minimally invasive procedures. Videoscopes typically include a camera at the end of a flexible member, as well as electronic image gathering equipment located near the instrument. The entire end of the flexible member is manipulated by the doctor so that the instrument end of the videoscope can be controlled by the doctor to carry out the desired medical or dental procedure. When carrying out an invasive procedure, the end of the videoscope is inserted through an incision in the patient's skin and guided by the doctor to the tissue site of interest. The imaging apparatus is often a miniature camera or a bundle of optical fibers which carry the composite image of the tissue site to image processing and display equipment located in view of the doctor. The videoscope also includes an image input device and a light producing mechanism to cast a beam of light on the area of the surgical procedure. By manipulating the end of the videoscope in or around the patient's tissue, the doctor can view the procedure on the video display, which might otherwise be very difficult or impossible for the doctor to see with the naked eye or head-mounted optical magnifying equipment.
In the periodontal area of practice, videoscopes are often employed to observe the gingival pocket or sulcus where granulation tissue is removed from the bone, or where plaque dental calculus is removed from the root cementum. The dental tool is inserted into the gingival pocket and manipulated by the doctor to carry out the procedure. At the same time, the doctor or an assistant will insert a water tube device and endoscope imager to lavage the area, and also to capture the area of operation so that it can be automatically enlarged and displayed to the doctor to facilitate the accuracy of use of the dental tool for removal of the undesired tissue without damaging the surrounding tissue. A liquid can be used to cleanse the lens of the imager so that a clear line of sight is maintained to the area of the procedure.
A problem often encountered with the use of an imaging type of endoscope or a videoscope is that of maintaining the lens or optical input of the imager clean during the procedure. It can be appreciated that when the optical input of the imager is embedded in fluids or becomes covered either partially or fully with blood or other body fluids, the image to be collected is often not discernable. The debris on the lens can cloud or fully obscure the tissue, whereupon the procedure must be temporarily discontinued until the lens is cleaned. Sometimes, the videoscope must be withdrawn from the patient before it can be manually cleaned.
In many surgical operations, the area of the procedure must be lavaged with a stream of water to clean the same. The flushing of the area often causes the debris to be splattered onto the lens of the imager, thus requiring the same to be removed and cleaned, or withdrawn somewhat during the lavage procedure. It can also be appreciated that even when water or another clear liquid is used to keep the lens clean, the cleaning liquid can often leave droplets on the lens, thereby creating inaccurate capturing of the image. In addition, in cases where the imager is immersed within the liquid during the operation, the motion and turbulence of the liquid produces inaccurate and distorted images.
In minimally invasive periodontal surgery, the surgical area is constantly bathed in a mixture of saliva and blood. When a conventional video imager is used, whether it be a miniature camera or the end of a fiber optic bundle, the optical input quickly becomes contaminated with blood and must be repeatedly cleaned. If a rotary or ultrasonic instrument is used, of the type that produces copious spray and blood-contaminated aerosols, the image captured becomes virtually unusable. This is also the case in many medical procedures that are “open” such as plastic surgery, tissue removal from the skin, etc. The image contamination problem is minimized in closed surgical procedures, such as abdominal surgery, by introducing a second or third tube that fills the abdomen with an inert gas (usually nitrogen), and also possibly a suction tube. The end of the videoscope nevertheless becomes contaminated and must be frequently removed and cleaned.
The cleaning of the imager at the end of an videoscope can often be accomplished by flooding the area with water or other clear liquid in order to rinse the residue off the lens. This is accomplished by providing a lumen in the flexible member of the videoscope to carry pressurized water from a reservoir to the end of the videoscope. Such videoscopes are described in U.S. Pat. No. 5,230,621 by Jacoby and U.S. Pat. No. 6,007,333 by Calan et al. These videoscopes are believed to function well for their intended purpose, but the excess liquid must be evacuated from the surgical site, or it will also obscure and interfere with the line of sight to the area of interest. In addition, a clean source of water must be available, as well as a system to pressurize the water or other clear cleaning liquid that is utilized. The videoscopes described in the prior art facilitate the removal of splatter once it accumulates on the lens of the imager by flooding the area adjacent the lens with water, but do not address prevention of the same.
From the foregoing, it can be seen that a need exists for a technique to employ a videoscope and prevent the lens of the imager from coming into contact with obscuring films and splatter, thus maintaining the lens clean without having to use a cleansing liquid or to purposefully clean the lens intermittently to maintain a clear line of sight to the tissue of interest. Another need exists for a videoscope that can be conveniently attached to a hand-held instrument. Another need exists for a videoscope that is particularly, but not exclusively, well adapted for surgical procedures including periodontal, plastic and facial procedures.